PROJECT SUMMARY/ABSTRACT Candidate?s Long-Term Career Goal: To become an independent investigator and decision scientist seeking to improve clinical decision-making in the intensive care unit (ICU). Clinical Problem to be Addressed: Each year, 10,000 Americans die from pneumonia, yet might not if they had received care in the ICU. This proposal?s overall hypothesis is that there are definable characteristics of patients who could benefit from ICU care but do not receive it, that those characteristics are often not incorporated into cognitive models of physician decision-making around ICU care, and that even when those models are accurate, hospital factors prevent physicians from providing potentially life-saving ICU care. Candidate?s Background and Achievements: Dr. Thomas Valley is a Lecturer in Pulmonary and Critical Care Medicine at the University of Michigan. He has earned a Master?s degree in healthcare research. To date, he has published 15 papers, including 9 original peer-reviewed research manuscripts, of which he was first author on 5, including 1 in JAMA. He has won 2 pilot grants and an NHLBI Loan Repayment award. His department?s strong commitment to him includes an appointment as Assistant Professor on June 1, 2018, regardless of the outcome of this proposal, with a start-up package including $250,000 of discretionary research funds. Career Development Plan: In order to achieve his goals, Dr. Valley proposes to develop new expertise in decision science through formal coursework and mentored research. His primary mentor is Theodore Iwashyna at Michigan, who has mentored 5 clinician-scientists on K awards, of whom 2 have already won R01 or equivalent awards. He is co-mentored by Angela Fagerlin, Chair of Population Health Sciences and a decision scientist at Utah, and Colin Cooke, an expert in ICU organization and policy at Michigan. Aims: Using both secondary analysis of existing data and primary data collection, he will 1) develop and validate a prediction model to identify patients with pneumonia who should be admitted to the ICU, but often are not; 2) empirically identify key decision-making models of physicians about ICU admission; and 3) characterize barriers and facilitators at the organizational-level to improving ICU admission practices. Deliverables from Aims: The proposed Aims will lead to 4 new papers and prepare Dr. Valley to write 1 R21 and 1 R01 proposal. The R21 will develop and pilot a tool to identify patients with pneumonia who should receive ICU care. The R01 will test this tool in a cluster randomized trial to improve ICU use for pneumonia.